Invasive staging of superior mediastinum in non-small cell lung cancer patients with specific indications

Abstract

This prospective study was done between February 2001 and December 2002 on 84 non-small cell lung cancer patients who were apparently operable. We selectively performed mediastinoscopy to 46 patients (54.76%, group 1) with the following indications: clinical T4 tumor, high operative risk, radiologically enlarged mediastinal lymph nodes, clinical T3 tumors with central location, radiologically identified mediastinal lymph nodes of any size with adeno or large cell carcinoma histology. Other 38 patients (45.23%, group 2) underwent thoracotomy without mediastinoscopy. Sensitivity, specificity, negative predictive value and positive predictive value of the indications were calculated. Cost analysis was done in the 84 patients and the results were compared with alternative mediastinal staging strategies (vs. routine, and vs. selectively to patients with radiologically positive mediastinal lymph nodes) if they had been applied to our population. Group 1 had higher selectivity to differentiate N2 patients (p=0.02). Sensitivity, specificity, negative predictive value and positive predictive value of indications were calculated as: 0.85, 0.54, 0.92 and 0.36, respectively. Our approach was most economical in terms of total cost per patient and money spent unnecessarily per patient. Mediastinal evaluation in operable lung cancer patients should decrease the number of surgical procedures, N2 disease found at thoracotomy and cost.

The Additional Value of FDG PET Imaging for Distinguishing N0 or N1 From N2 Stage in Preoperative Staging of Non-small Cell Lung Cancer in Region Where the Prevalence of Inflammatory Lung Disease Is High

“…However, it should be borne in mind that, the false-negative rate of mediastinoscopy is still around 10% as seen in our 2 (8.3%) out of 24 cases. 26 Moreover, the procedure itself is invasive and risky as well as the cost is high. 27 So we believe that routine mediastinoscopy alone is not enough for perfect mediastinal staging.…”

Prediction of Cardiopulmonary Morbidity after Resection for Lung Cancer: Stair Climbing Test Complications after Lung Cancer Surgery

“…We prospectively entered the data forms of the 150 patients (127 male, 23 female) who underwent lobectomy (n = 101), or pneumonectomy (n = 27) or sleeve lobectomy (n = 22) for non-small cell carcinoma into the data bank. Resectability was assessed by means of a chest computer tomography, bronchoscopy and mediastinoscopy when indicated [9]. All lung cancer patients who were candidates for resection carried out the stair climbing exercise test prospectively.…”